Times Telegram: New Care Standards Lower Sepsis Death Rate

New York has reduced the number of residents dying of sepsis since new regulations kicked in in 2014, state data shows.

Rory’s Regulations, named after Rory Staunton, 12, of Queens, who died of sepsis after a 2012 fall in the school gym, require hospitals to develop and implement protocols to diagnose and treat sepsis early, the first such requirement in the nation.

The protocols are needed, said Dr. Maria Gesualdo, president of Slocum-Dickson Medical Group and a pulmonary critical care specialist who’s heading up the sepsis initiative at the Mohawk Valley Health System.

“When somebody comes through the (emergency department), there’s a stroke alert,” she said. “We have protocols for myocardial infarction (heart attacks) … but we never had anything for sepsis.”

Sepsis, a dangerous reaction to infection, can progress rapidly, leading to the shutdown of the body’s organs and systems, making early intervention critical. It strikes 750,000 Americans each year, killing 200,000. It is the No. 1 cause of death in the hospital and the 11th leading cause of death overall.

In New York, mortality rates for sepsis among adults fell from 30.2 percent to 25.4 percent from mid-2014 through the end of September in 2016, according to the New York State Department of Health study. And the number of patients diagnosed with sepsis rose 20 percent, meaning hospitals got better at identifying patients, according to the study.

Much of the effort centers around screening all patients with infections to see if they may have or be at risk for sepsis, and the use of two protocol “bundles” for patients with sepsis. A bundle is a group of tests and treatments that all patients matching certain criteria should receive.

The three-hour bundle — care to be delivered within three hours — is to resuscitate patients who are severely septic or in septic shock, Gesualdo said. A six-hour bundle is for patients admitted with sepsis.

It’s not that doctors didn’t already know what to do, but they tended to “piecemeal” their treatments.

“Having it all in one order set, we capture everything,” she said. “We don’t miss any of the important elements.”

At Bassett Medical Center, Rory’s Regulations spurred specific initiatives such as a sepsis work group, an alert system for possible symptoms built into the electronic medical record, a rapid response team for a “coordinated and choreographed response,” and provider and nurse education, including the production of a new training video, said Chief of Medicine Dr. Charles Hyman.

“As a result of the above initiatives, Bassett Medical Center has made considerable progress over the past couple years,” he said. “Our 2016 compliance rate is above that of the (New York state) mean for sepsis protocol.”

That means more patients are receiving the prescribed care — such as a systemic antibiotic within one hour of diagnosis — quickly and fully. And the hospital’s sepsis mortality rate is falling below the state average, Hyman said.

The sepsis initiative has been important to spread awareness of a deadly issue and things are definitely improving, Gesualdo said. But perfect compliance doesn’t happen overnight. “It’s really a big initiative. We still have to iron out some wrinkles,” she said.

“It’s everybody’s responsibility,” she added. “We all have to work as a team. We need that nudging till it becomes knee-jerk response.”